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Bottle worries

Hi,

I have a wonderful 3 month old son, who is a breastfeeding champion. He breastfeeds exclusively, and feeds on demand. This has been working wonderfully for us both since his birth. In just a week, though, I will be going back to work. I've already started pumping milk and have the bottles ready, but the few times we've tried to give him a bottle of breast milk, he has not cooperated and has gotten really upset. I don't want to stop comfort nursing him - I love being able to calm him down by nursing. But it does make it a lot harder to know when he is actually very hungry.

He'll have a nanny who will spend the days with him at my house, and will defrost and heat my milk to give him. How, though, can we all deal with the fact that he doesn't have a feeding schedule? Heating the milk, obviously, takes time, and if he shows signs of hunger and the milk is then heated, he is often pretty hysterical by the time it is ready, and is too worked up to take the bottle, since it is a new thing to him. Also, if the nanny heats a bottle and it turns out he is not hungry, that is milk wasted!

Any suggestions for how to deal with the transition to bottle feeding during the day? Thank you so much in advance!

Re: Bottle worries

Hi & Welcome! The transition back to work is often so very stressful for both mom and baby. But it will be ok. Your concerns are very common.

Defrosting and warming frozen breastmilk in the amounts a baby will normally take them does NOT take much time. It can be done in just a few minutes of bottle or bag being run under water from the faucet or sitting in a bowl of warm water. Whether it needs to be heated further depends on baby, some babies prefer cold milk in the bottle. But again, in small amounts of-2-4 ounces, this should take a few minutes only.

Also, milk for the day can be taken from the freezer and put in the fridge in the morning to defrost, or even the night before if needed. The trick is to not take out too much, as of course, any extra that is needed can again be quickly brought to eating temp with the method above.

Also, if the nanny warms a bottle and it turns out he is not hungry, that is milk wasted!

No it isn't. If baby never touches the bottle, it can go back in the fridge for the next day, or even refrozen. OR, if baby is just not hungry at that moment but will be hungry soon, it can be left on the counter until baby is ready. OR, If baby drinks part of the bottle, it can go back in the fridge until the next feeding.

Do not use formula recommendations for storing and using expressed breastmilk! Breastmilk is much more naturally resistant to bacteria growth than is formula. I am linking the current recommendations below.

For the bottle refusal. try not to stress. There are many ways to approach this. There are a few articles on thios site that address this. And here is one way that worked for a mom I was helping recently: This week, as often as you like (but not too often) offer baby a bottle with just a little bit of milk in it when baby is not hungry AT ALL. Or offer the empty bottle. Let baby explore the scent and shape and feel of the bottle with no pressure from you or his tummy. Let him play with it. When he will suck on or mouth the nipple without fear or resistance, try offering him a bottle, again, with a very small amount of milk in it, when he is slightly hungry. Take this as slow as your baby needs. Use paced bottle feeding techniques for positioning and allowing baby-signaled pauses so baby is never overwhelmed by the amount of milk that comes from the bottle (even with slow flow nipples.)

Teach your nanny paced bottle feeding techniques and how to recognize feeding cues. If she is unfamiliar with the latest guidelines for handling expressed breastmilk, teach those to her as well.

I am sure moms who have btdt will have many great suggestions for you as well

This is a good video on paced bottle feeding. But imo you can ignore what she says about timing the pauses during the feedings or about time between feedings. Every baby is going to be individual in these I think. http://www.bing.com/videos/search?q=...FD00534CAAC56E

Re: Bottle worries

Thank you!! My baby is on day 2 with his nanny today (I'm at home, too, but he's spending the days mostly with her) and he is ding fine and has taken bottles with no problem. He is, though, eating SIGNIFICANTLY less than usual. His nanny has been very good about not forcing the bottle on him (when he starts to cry she takes it away until he shows signs of hunger again) and is not feeding him on a schedule, only on demand. The problem is that he is simply not demanding! Because I usually feed him directly on the breast I don't know exactly how much he drinks, but he nurses very often normally. Yesterday he drank about 6.5 ounces of milk from 7:30am - 4pm, and today he has only drank about 5 ounces (from 7:30am - 3pm). He also did not have a dirty diaper yesterday, and has not yet today, whereas he was on a rhythm of one dirty diaper a day.

He seems perfectly contented and is simply not showing interest in eating, but does play and smile like normal.

I am pumping about 15 ounces a day (between 7:30am and 4pm - I pump 5 ounces three times a day), because that is what is comfortable to me after having exclusively nursed him for three months, which makes me think that that's about what he usually consumes. It also means that the freezer is jam packed with milk!!

Should I be concerned? Will he start eating more as he gets used to the bottles? I have had an oversupply issue, so maybe I'm able to pump so much because of that?

Re: Bottle worries

Was baby nursing a lot when he was back to breastfeeding? It's not unusual for babies to "reverse cycle," ie wait for mom! In that scenario, baby doesn't drink much from the bottle during the day, and nurses lots and lots when reunited with mom. As long as baby is making up for the decreased milk intake during the day with lots of nursing later, it's perfectly fine - actually in some ways it's ideal, because it ensures baby is doing lots of nursing when you are together, which maintains supply better than the pump (usually) and also, of course, fosters the bond between you and baby and gives him all the other benefits of lots of nursing. Also keep in mind that the average 24 hour milk intake for a baby over the age of 1 month is 24 oz. This leads to a "usual" expressed milk intake is between 1 and 1.5 oz per hours - the higher end would be for babies who don't do as much nursing overnight, for example, whereas the lower end would be for a baby who takes in about as much milk during the day as he does at night. So from 7:30 am to 4 pm 8.5 oz would be at the lower end of that range, and 6.5 oz is not too much below that - one extra nursing session when you're together can make up the 2 oz difference. Also, keep in mind that this is a transition period, and baby might not continue to have exactly the same pattern over time. But, if he does, as long as you are doing lots of nursing when you are together, and weight gain is keeping pace, low expressed milk intake during the day is not a cause for concern. As for your pumping output, it sounds excellent! It could be that you do have some degree of oversupply, it could be that baby was actually nursing more during the day when you were nursing him all day. Either way, I would suggest taking advantage of this to build up your freezer supply. It could be that as supply regulates and/or you are relying more on the pump to maintain supply, that you will see a drop in the amount you pump. That's great that your nanny is feeding your baby in a breastfeeding-supportive way, and that LO is taking the bottle! Good luck with the return to work.

Re: Bottle worries

I agree with bfwmomof3. It may be what you pump, but 15 ounces would be a lot for a baby to take in during the average work day, unless baby never nurses overnight. Yes this intake of the past two days is on the low side on paper, but I think a few days of less intake, even much less intake, for a healthy 3 month old is not a big deal. Everyone is transitioning to the new normal and that takes time! It sounds as if you and your nanny are respecting your baby's signals and I think that is probably the best way to go.

Re: Bottle worries

Thank you so much for this reassurance! He had vaccines yesterday and a fever today, so through fear of dehydration I forced the bottle a bit...it just sent him into a crying fit. Certainly don't want him to have bad assocations with the bottle on top of everything! As hard as it is not to worry, I will do my best to trust his nanny and believe that as long as he's acting happy, he IS happy. Thanks again!!

Re: Bottle worries

And a note: at the end of the day when he's back to breastfeeding he nurses a TON. He also nurses every hour or two all night, and rarely if ever even spits anything up during night feedings. So as I think about it, he probably IS making up for any missed meals.

Re: Bottle worries

Just wanted to tell you I've been there and done that. My baby refused the bottle for the first feeding of the day I left him with a babysitter when I went back to work. By the end of the day he had eaten a total of 2 ounces. Next day he had 3. Then for 2 weeks or so, he was doing a bit better but still nowhere near the usual 1 oz per hour or so. Finally he began to take them after about 2 weeks. Still, he only eats about 8-9 ounces in 8 hours. But he's been like that for several months now and he's gaining weight fine so I'm not concerned about that. Even the days my baby ate so little all day, he was HAPPY. I'm glad the babysitter didn't force it on him. We don't make him eat ever, same with nursing. I try for a minute or two and if I see he keeps turning away, I give up and try later. Your baby will make up for eating less by day during the time you're with him. I never was able to measure that because when he nursed after work, I don't know how much he had.

Like Meg said, heating bottles shouldn't take long at all. Fill up a bowl with hot water from the sink and plunk your milk in there. Bags warm up much quicker than bottles do so store in bags if possible.

Re: Bottle worries

Originally Posted by @llli*lalalizzie

And a note: at the end of the day when he's back to breastfeeding he nurses a TON. He also nurses every hour or two all night, and rarely if ever even spits anything up during night feedings. So as I think about it, he probably IS making up for any missed meals.